Outline

Objective

In older patients depending on "biological age" and other individual facts, the best therapeutic approach is often difficult to decide, due to the higher risk of postoperative complications. Especially for those cases, radiosurgery (RS) / stereotactic radiotherapy (SRT) can be an alternate treatment option which can provide some useful indications.

Methods

From 05/00 until 10/03, 447 patients were treated with RS/SRT, among them 141 (31%), 73 (16%) and 12 (3%) were in the age ranges of 60-69, 70-79 and 80-93 years respectively. There were 58/113 (51%) patients with meningeomas, 74/108 (68%) brain metastases, 33/62 (53%) most acoustic neuromas, 28/47 (60%) pituitary adenomas, 25/85 (29%) other tumors, 2/25 AVM and 6/7 trigeminal neuralgia. We observed the follow-up, and also any special aspects - particulary of those patients with benign tumors -up until abstract submission.

Results

In neuromas/pituitary adenomas no tumor progression and no surrounding reactions have been observed. In 14 neuromas and 10 pituitary adenomas we could prove tumor shrinkage with image fusion. Meningeomas: 5 surgical procedures were necessary (1 tumor progression after 2 y and 2 severe reactions in sinus-falx recurrent tumors, 2x hydrocephalus), 5 other temporary moderate reactions in hemispheric recurrent tumors (>10ccm) were treated with Dexamethasone. Tumor shrinkage was proven in 22 cases. No problems were seen in skull base meningeomas. Only 2/55 pat.< 60 y had moderate reactions. In all benign tumors SRT was as effective as RS concerning tumor regression. Further follow-up is required.

Conclusions

An individual and interdisciplinary decision is very important for each case. RS/SRT is an effective treatment option for tumor control with low risk except of hemispheric meningeomas > 10 ccm - particulary in elderly patients (attention in those cases!). The treatment should only be done if a tumor progression was provable, no signs of decompensation can be recognized and the patient is still in a good condition. In cases of tumours >4 ccm and those near critical structures it is favourable to use SRT.